Sexually Transmitted Disease Surveillance 1994

Division of STD Prevention

September 1995

U.S. Department of Health and Human Services
Public Health Service
Centers for Disease Control and Prevention 
National Center for HIV, STD, and TB Prevention (proposed)
Division of STD Prevention
Atlanta, Georgia 30333

                         Copyright Information 

All material contained in this report is in the public domain and may be
used and reprinted without special permission; citation to source, however,
is appreciated.

                           Suggested Citation

Division of STD Prevention. Sexually Transmitted Disease Surveillance,
1994. U.S. Department of Health and Human Services, Public Health Service.
Atlanta: Centers for Disease Control and Prevention, September 1995.

Copies can be obtained from Information Technology and Services Office,
National Center for HIV, STD, and TB Prevention (proposed), Centers for
Disease Control and Prevention, 1600 Clifton Road, Mailstop E-06, Atlanta,
Georgia 30333 or by telephone at (404) 639-1819.

Both the 1993 and 1994 reports are now available electronically on CDC
WONDER. For information about registering for CDC WONDER, please contact
CDC's Information Resource Management Office at (404) 332-4569.
                  
                  STDs in Adolescents and Young Adults

Public Health Impact

Adolescents (10- to 19-year-olds) and young adults (20- to 24-year-olds)
are at higher risk for acquiring STDs for a number of reasons:  they may be
more likely to have multiple (sequential or concurrent) sexual partners
rather than a single, long-term relationship; they may be more likely to
engage in unprotected intercourse; and they may select partners at higher
risk. In addition, for some STDs, e.g., Chlamydia trachomatis, adolescent
women may have a physiologically increased susceptibility to infection due
to increased cervical ectopy and lack of immunity. During the past two
decades, premarital sexual experience among adolescent women has steadily
increased resulting in an enlarging pool of young women at risk (1,2). 

Observations

 --  Numerous prevalence studies in various clinic populations have shown
     sexually active adolescents have high rates of chlamydial infection
     (3). Large-scale screening demonstrations projects in federal Region X
     (Alaska, Idaho, Oregon, and Washington) (4) have demonstrated that
     younger women have consistently higher positivity rates of chlamydia
     than older women (Figure_E).

 --  Rates of gonorrhea in 10- to 14-year-old and 15- to 19-year-old
     adolescents have decreased steadily from the mid-1980s, up to 1993.
     However, this group of adolescents showed an increase in the reported
     rate of gonorrhea between 1993 and 1994. The 10- to 14-year-old group
     increased slightly from 50.0 in 1993 to 50.4 in 1994. The 15- to
     19-year-old group increased from 742.1 in 1993 to 763.4 in 1994. The
     latter represented a 2.9% increase (Table_9B). This represents the
     first increase in gonorrhea among adolescents (10- to 19-year-olds)
     since 1985-1986.

 --  The increase in gonorrhea among adolescents in both age groups is
     entirely attributed to increases among adolescent females. In these
     age groups, young females have had higher gonorrhea rates than young
     males (Table_9B). Young males continued to show decreases in
     gonorrhea from 1993 to 1994 in both age groups. However both groups of
     young females showed increases (Figure_F). Gonorrhea rates among
     10- to 14-year-old females increased from 80.3 in 1993 to 85.9 in
     1994, a 7.0% increase. Rates among 15- to 19-year-old females
     increased from 868.0 to 926.7, a 6.8% increase.

 --  Increases in gonorrhea in 1994 vs. 1993 among young females were
     demonstrated in whites, African-Americans, Hispanics (10- 14-year-olds
     only), and Asian/Pacific Islanders (Table_9B).

(1) CDC. Premarital sexual experience among adolescent women -- United
States, 1970-1988. MMWR 1991;39:929-32.

(2) CDC. Pregnancy, Sexually Transmitted Diseases and Related Risk
Behaviors Among U.S. Adolescents. Atlanta: Centers for Disease Control and
Prevention, 1994. Adolescent Health: State of the Nation monograph series,
No. 2. CDC Publication No. 099-4630.

(3) CDC. Recommendations for the prevention and management of Chlamydia
trachomatis infections, 1993. MMWR 1993;42(No. RR-12).

(4) Lossick J, Delisle S, Fine D, Mosure D, Lee V, Smith C. Regional
program for widespread screening for Chlamydia trachomatis in family
planning clinics. In: Bowie WR, Caldwell HD, Jones RP, et al., eds.
Chlamydial Infections: Proceedings of the Seventh International Symposium
of Human Chlamydial Infections, Cambridge, Cambridge, University Press,
1990, pp. 575-9.

Figure_E. Chlamydia - Percent positivity among women tested in family
              planning clinics by age group: Region X, 1988-1994    
Figure_F. Gonorrhea - Age-specific rates among women 10-44 years of
              age: United States, 1981-1994    
Figure_G. Gonorrhea - Age-specific rates among men 10-44 years of age:
              United States, 1981-1994    

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